tbuckley/cabot-search huggingface dataset:
The use of environmental scenarios to project future health effects: a scoping review
Authors: Eartha Weber, George S Downward, Kristie L Ebi, Paul L Lucas, Detlef van Vuuren
Journal: The Lancet Planetary Health (2023)

Environmental risks are a substantial factor in the current burden of disease, and their role is likely to increase in the future. Model-based scenario analysis is used extensively in environmental sciences to explore the potential effects of human activities on the environment. In this Review, we examine the literature on scenarios modelling environmental effects on health to identify the most relevant findings, common methods used, and important research gaps. Health outcomes and measures related to climate change (n=106) and air pollution (n=30) were most frequently studied. Studies examining future disease burden due to changes or policies related to dietary risks were much less common (n=10). Only a few studies assessed more than two environmental risks (n=3), even though risks can accumulate and interact with each other. Studies predominantly covered high-income countries and Asia. Sociodemographic, vulnerability, and health-system changes were rarely accounted for; thus, assessing the full effect of future environmental changes in an integrative way is not yet possible. We recommend that future models incorporate a broader set of determinants of health to more adequately capture their effect, as well as the effect of mitigation and adaptation efforts.
Climate-sensitive health counselling: a scoping review and conceptual framework
Authors: Claudia Quitmann, Silvan Griesel, Patricia Nayna Schwerdtle, Ina Danquah, Alina Herrmann
Journal: The Lancet Planetary Health (2023)

Health professional societies and researchers call for the integration of climate change into health counselling. However, the scientific evidence and conceptual grounding of such climate-sensitive health counselling (CSHC) remains unclear. We conducted a scoping review identifying scientific articles on the integration of climate change into communication between health professionals and patients in health-care settings. Scientific databases (Web of Science, PubMed, and Google Scholar) were searched from inception until Nov 30, 2022. 97 articles were included, of which 33 represented empirical research, and only two evaluated the effects of CSHC. More than half of the articles originated from the USA and addressed physicians. We introduce a conceptual framework for CSHC, which elaborates on aims, content areas, and communication strategies, and establishes the guiding principle of integrating CSHC into routine activities of health care. This framework supports health professionals in implementing CSHC and enables researchers to conceptualise intervention studies investigating how CSHC can contribute to the health of patients and the planet.
Assessing the potential climate impact of anaesthetic gases
Authors: Mads Peter Sulbaek Andersen, Ole John Nielsen, Jodi D Sherman
Journal: The Lancet Planetary Health (2023)

There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce pollution from clinical practice. Inhaled anaesthetics is a particular research area of interest for two reasons. First, several gases are potent greenhouse gases, and waste gas is mostly emitted directly to the environment. Second, there are options to reduce gas waste and substitute medications and procedures with fewer embodied emissions while delivering high-quality care. Performance improvements are contingent on a proper understanding of the emission estimates and climate metrics used to ensure consistent application in guiding mitigation strategies and accounting at various scales. We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs: desflurane, sevoflurane, isoflurane, methoxyflurane, and nitrous oxide.
Environmentally sustainable surgical health systems: an analysis of policies, tools, and guidelines
Authors: Anisa Nazir, Xiya Ma, Dominique Vervoort
Journal: The Lancet Planetary Health (2023)

Climate change and insufficient access to surgical care are two intersecting global health challenges that disproportionately affect populations in areas, such as low-income and middle-income countries (LMICs), rural and remote communities, and island states. Five billion people worldwide have no access to safe surgical care and anaesthesia, resulting in over 17 million preventable deaths per year.1 In 2015, The Lancet Commission on Global Surgery recommended scaling up surgical, anaesthesia, and obstetrics care through National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs), as a strategic effort embedded within countries’ national health plans.
Determinants of worldwide antibiotic resistance dynamics across drug-bacterium pairs: a multivariable spatial-temporal analysis using ATLAS
Authors: Eve Rahbe, Laurence Watier, Didier Guillemot, Philippe Glaser, Lulla Opatowski
Journal: The Lancet Planetary Health (2023)

Antibiotic resistance (ABR) is a major concern for global health. However, factors driving its emergence and dissemination are not fully understood. Identification of such factors is crucial to explain heterogeneity in ABR rates observed across space, time, and species and antibiotics.We analysed count data of clinical isolates from 51 countries over 2006-19 for thirteen drug-bacterium pairs taken from the ATLAS database. We characterised ABR spatial and temporal patterns and used a mixed-effect negative binomial model, accounting for country-year dependences with random effects, to investigate associations with potential drivers, including antibiotic sales, economic and health indicators, meteorological data, population density, and tourism.ABR patterns were strongly country and drug-bacterium pair dependent. In 2019, median ABR rates ranged from 6·3% (IQR 19·7% [0·5-20·2]) for carbapenem-resistant Klebsiella pneumoniae to 80·7% (41·8% [50·4-92·2]) for fluoroquinolone-resistant Acinetobacter baumannii, with heterogeneity across countries. From 2006 to 2019, carbapenem resistance increased in more than 60% of investigated countries; no global trend was observed for other resistances. Multivariable analyses identified significant associations of ABR with country-level selecting antibiotic sales, but only in fluoroquinolone-resistant-Escherichia coli, fluoroquinolone-resistant-Pseudomonas aeruginosa, and carbapenem-resistant-A baumannii. We also found a correlation between temperature and resistance in Enterobacteriaceae and with the health system quality for all drug-bacterium pairs except Enterococci and Streptococcus pneumoniae pairs. Despite wide consideration of possible explanatory variables, drug-bacterium pair ABR rates still showed unexplained spatial random effects variance.Our findings reflect the diversity of mechanisms driving global antibiotic resistance across pathogens and stress the need for tailored interventions to tackle bacterial resistance.Independent research Pfizer Global Medical Grant and ANR Labex IBEID.
Women's empowerment, production choices, and crop diversity in Burkina Faso, India, Malawi, and Tanzania: a secondary analysis of cross-sectional data
Authors: Kaela Connors, Lindsay M Jaacks, Ananya Awasthi, Karoline Becker, Rachel Bezner Kerr, Emily Fivian, Aulo Gelli, Helen Harris-Fry, Jessica Heckert, Suneetha Kadiyala, Elena Martinez, Marianne V Santoso, Sera L Young, Lilia Bliznashka
Journal: The Lancet Planetary Health (2023)

BackgroundBolstering farm-level crop diversity is one strategy to strengthen food system resilience and achieve global food security. Women who live in rural areas play an essential role in food production; therefore, we aimed to assess the associations between women's empowerment and crop diversity.MethodsIn this secondary analysis of cross-sectional data, we used data from four cluster-randomised controlled trials done in Burkina Faso, India, Malawi, and Tanzania. We assessed women's empowerment using indicators from the Women's Empowerment in Agriculture Index. Farm-level crop diversity measures were the number of food crops grown, number of food groups grown, and if nutrient-dense crops were grown. We used a two-stage modelling approach. First, we analysed covariate-adjusted country-specific associations between women's empowerment and crop diversity indicators using multivariable generalised linear models. Second, we pooled country-specific associations using random-effects models.FindingsThe final analytic sample included 1735 women from Burkina Faso, 4450 women from India, 547 women from Malawi, and 574 women from Tanzania. Across all countries, compared with households in which women provided input into fewer productive decisions, households of women with greater input into productive decisions produced more food crops (mean difference 0·36 [95% CI 0·16–0·55]), a higher number of food groups (mean difference 0·16 [0·06–0·25]), and more nutrient-dense crops (percentage point difference 3 [95% CI 3–4]). Across all countries, each additional community group a woman actively participated in was associated with cultivating a higher number of food crops (mean difference 0·20 [0·04–0·35]) and a higher number of food groups (mean difference 0·11 [0·03–0·18]), but not more nutrient-dense crops. In pooled associations from Burkina Faso and India, asset ownership was associated with cultivating a higher number of food crops (mean difference 0·08 [0·04–0·12]) and a higher number of food groups (mean difference 0·05 [0·04–0·07]), but not more nutrient-dense crops.InterpretationGreater women's empowerment was associated with higher farm-level crop diversity among low-income agricultural households, suggesting that it could help enhance efforts to strengthen food system resilience.FundingBill & Melinda Gates Foundation.
Health benefits of Open Streets programmes in Latin America: a quantitative health impact assessment
Authors: Daniel Velázquez-Cortés, Mark J Nieuwenhuijsen, Michael Jerrett, David Rojas-Rueda
Journal: The Lancet Planetary Health (2023)

BackgroundTo improve physical activity in Latin American cities, several interventions have been promoted, such as Open Streets programmes. Our study aims to quantify the health and economic effects of Open Streets-related physical activity in 15 Latin American cities.MethodsWe used a quantitative health impact assessment approach to estimate annual premature deaths and disease incidence (ischaemic heart disease, ischaemic stroke, type 2 diabetes, colon cancer, breast cancer, and dementia) avoided, the disability-adjusted life-years (DALYs) gained, and the cost saving (from reduced premature mortality) related to increased physical activity from Open Streets programmes in 15 Latin American cities. Input data were obtained from scientific publications, reports, and open street city surveys spanning 2017 to 2019. Physical activity data were converted to metabolic equivalent of the task. Exposure–response relationship functions were applied to estimate relative risk and population-attributable fraction, enabling the assessment of premature deaths and disease incidence.FindingsThe percentage of male users of the Open Streets programmes ranged from 55% (27 500 of 50 000 in Guatemala) to 75% (2250 of 3000 in El Alto, Bolivia), and female users ranged from 25% (750; El Alto) to 45% (22 500; Guatemala). We estimated that the current Open Streets programmes in the 15 Latin American cities studied could prevent 363 (95% CI 271–494) annual premature deaths due to increased physical activity, with an annual economic impact of US$194·1 million (144·9 million–263·9 million) saved and an annual reduction of 1036·7 DALYs (346·7–1778·3). If one Open Streets event is added per week in each of those cities, the potential benefit could increase to 496 (370 to 677) premature deaths prevented each year.InterpretationOpen Streets programmes in Latin America can provide health and economic benefits related to increased physical activity and can be used as a health promotion and disease prevention tool.FundingEU's Horizon 2020 research and innovation programme.
Finerenone Added to RAS/SGLT2 Blockade for CKD in Alport Syndrome. Results of a Randomized Controlled Trial with Col4a3 −/− Mice
Authors: Zhihui Zhu, Karoline A.T. Rosenkranz, Yoshihiro Kusunoki, Chenyu Li, Martin Klaus, Oliver Gross, Maria-Lucia Angelotti, Giulia Antonelli, Luigi Cirillo, Paola Romagnani, Nassim Bouteldja, Alireza Vafaei Sadr, Roman D. Bülow, Peter Boor, Hans-Joachim Anders
Journal: Journal of the American Society of Nephrology (2023)

We hypothesized that triple therapy with inhibitors of the renin-angiotensin system (RAS), sodium-glucose transporter (SGLT)-2, and the mineralocorticoid receptor (MR) would be superior to dual RAS/SGLT2 blockade in attenuating CKD progression in Col4a3 -deficient mice, a model of Alport syndrome. Late-onset ramipril monotherapy or dual ramipril/empagliflozin therapy attenuated CKD and prolonged overall survival by 2 weeks. Adding the nonsteroidal MR antagonist finerenone extended survival by 4 weeks. Pathomics and RNA sequencing revealed significant protective effects on the tubulointerstitium when adding finerenone to RAS/SGLT2 inhibition. Thus, triple RAS/SGLT2/MR blockade has synergistic effects and might attenuate CKD progression in patients with Alport syndrome and possibly other progressive chronic kidney disorders.
Pulmonary Hypertension in Myeloproliferative Neoplasms: New Insights and Unexplored Horizons
Authors: Orly Leiva, Brenda D. Garcia, Gabriela Hobbs
Journal: American Journal of Respiratory and Critical Care Medicine (2023)

"Pulmonary Hypertension in Myeloproliferative Neoplasms: New Insights and Unexplored Horizons." American Journal of Respiratory and Critical Care Medicine, 0(ja), pp.
Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine
Authors: Bradley J. Petek, Mostafa A. Al-Alusi, Nathaniel Moulson, Aubrey J. Grant, Cyril Besson, J. Sawalla Guseh, Meagan M. Wasfy, Vincent Gremeaux, Timothy W. Churchill, Aaron L. Baggish
Journal: Journal of the American College of Cardiology (2023)
Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests
Authors: Martin Jonsson, Ellinor Berglund, Enrico Baldi, Maria Luce Caputo, Angelo Auricchio, Marieke T. Blom, Hanno L. Tan, Remy Stieglis, Linn Andelius, Fredrik Folke, Jacob Hollenberg, Leif Svensson, Mattias Ringh
Journal: Journal of the American College of Cardiology (2023)
Annals Graphic Medicine - A Graphical Abstract Examining Moral Distress and Coping Practices Among Clinicians During the COVID-19 Pandemic
Authors: Lingsheng Li, Amy Rosenwohl-Mack, Elizabeth Dzeng
Journal: Annals of Internal Medicine (2023)

Web ExclusivesJuly 2023Annals Graphic Medicine - A Graphical Abstract Examining Moral Distress and Coping Practices Among Clinicians During the COVID-19 PandemicFREELingsheng Li, MD, MHS, Amy Rosenwohl-Mack, RN, MSc, and Elizabeth Dzeng, PhD, MD, MPH, MPhil, MSLingsheng Li, MD, MHSUniversity of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)Search for more papers by this author, Amy Rosenwohl-Mack, RN, MScUniversity of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)Search for more papers by this author, and Elizabeth Dzeng, PhD, MD, MPH, MPhil, MSUniversity of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G22-0054 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Lingsheng Li, MD, MHS; Amy Rosenwohl-Mack, RN, MSc; Elizabeth Dzeng, PhD, MD, MPH, MPhil, MSAffiliations: University of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G22-0054.Acknowledgment: We would like to express our sincere gratitude for all the clinicians who participated in our study. Their stories continue to inspire us to amplify and honor the voices of health care workers who demonstrated humanity, courage, and vulnerability amidst tremendous suffering. Additionally, we would like to acknowledge Dr. Susan DeSanto-Madeya and Dr. Nathan Gray for their inspiration, contributions, and advice for our graphic narrative.Author/Illustrator Information: Lingsheng Li, MD, MHS, Division of Geriatrics, Department of Medicine, University of California, San Francisco, California (e-mail, Lingsheng.Li@ucsf.edu). Amy Rosenwohl-Mack, RN, MSc, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California. Elizabeth Dzeng, PhD, MD, MPH, MPhil, MS, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, and Cicely Saunders Institute, King's College, London, England.This article was published at Annals.org on 11 July 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics July 2023Volume 176, Issue 7 ePublished: 11 July 2023 Issue Published: July 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Decompression Illness in Divers With or Without Patent Foramen Ovale
Authors: Hyun-Jong Lee, Dal Soo Lim, Juneyoung Lee, Dong-geun Lee, Mi-Young Oh, Jinsik Park, Chi-Hoon Kim, Ji-Hyun Jung, Rak Kyeong Choi, Young Cheon Kang
Journal: Annals of Internal Medicine (2023)

Background: In previous studies, the prevalence of patent foramen ovale (PFO) has been reported to be higher in scuba divers who experienced decompression illness (DCI) than in those who did not. Objective: To assess the association between PFO and DCI in scuba divers. Design: Prospective cohort study. Setting: Tertiary cardiac center in South Korea. Participants: One hundred experienced divers from 13 diving organizations who did more than 50 dives per year. Measurements: Participants had transesophageal echocardiography with a saline bubble test to determine the presence of a PFO and were subsequently divided into high- and low-risk groups. They were followed using a self-reported questionnaire while blinded to their PFO status. All of the reported symptoms were adjudicated in a blinded manner. The primary end point of this study was PFO-related DCI. Logistic regression analysis was done to determine the odds ratio of PFO-related DCI. Results: Patent foramen ovale was seen in 68 divers (37 at high risk and 31 at low risk). Patent foramen ovale–related DCI occurred in 12 divers in the PFO group (non-PFO vs. high-risk PFO vs. low-risk PFO: 0 vs. 8.4 vs. 2.0 incidences per 10 000 person-dives; P = 0.001) during a mean follow-up of 28.7 months. Multivariable analysis showed that high-risk PFO was independently associated with an increased risk for PFO-related DCI (odds ratio, 9.34 [95% CI, 1.95 to 44.88]). Limitation: The sample size was insufficient to assess the association between low-risk PFO and DCI. Conclusion: High-risk PFO was associated with an increased risk for DCI in scuba divers. This finding indicates that divers with high-risk PFO are more susceptible to DCI than what has been previously reported and should consider either refraining from diving or adhering to a conservative diving protocol. Primary Funding Source: Sejong Medical Research Institute.
Risk for Chronic Kidney Disease Progression After Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort Study
Authors: Anthony N. Muiru, Jesse Y. Hsu, Xiaoming Zhang, Lawrence J. Appel, Jing Chen, Debbie L. Cohen, Paul E. Drawz, Barry I. Freedman, Alan S. Go, Jiang He, Edward J. Horwitz, Raymond K. Hsu, James P. Lash, Kathleen D. Liu, Ian E. McCoy, Anna Porter, Panduranga Rao, Ana C. Ricardo, Hernan Rincon-Choles, James Sondheimer, Jonathan Taliercio, Mark Unruh, Chi-yuan Hsu, Harold I. Feldman, Robert G. Nelson, Mahboob Rahman, Vallabh O. Shah
Journal: Annals of Internal Medicine (2023)

Background: Prior studies associating acute kidney injury (AKI) with more rapid subsequent loss of kidney function had methodological limitations, including inadequate control for differences between patients who had AKI and those who did not. Objective: To determine whether AKI is independently associated with subsequent kidney function trajectory among patients with chronic kidney disease (CKD). Design: Multicenter prospective cohort study. Setting: United States. Participants: Patients with CKD (n = 3150). Measurements: Hospitalized AKI was defined by a 50% or greater increase in inpatient serum creatinine (SCr) level from nadir to peak. Kidney function trajectory was assessed using estimated glomerular filtration rate (eGFR) based on SCr level (eGFRcr) or cystatin C level (eGFRcys) measured at annual study visits. Results: During a median follow-up of 3.9 years, 433 participants had at least 1 AKI episode. Most episodes (92%) had stage 1 or 2 severity. There were decreases in eGFRcr (−2.30 [95% CI, −3.70 to −0.86] mL/min/1.73 m2) and eGFRcys (−3.61 [CI, −6.39 to −0.82] mL/min/1.73 m2) after AKI. However, in fully adjusted models, the decreases were attenuated to −0.38 (CI, −1.35 to 0.59) mL/min/1.73 m2 for eGFRcr and −0.15 (CI, −2.16 to 1.86) mL/min/1.73 m2 for eGFRcys, and the CI bounds included the possibility of no effect. Estimates of changes in eGFR slope after AKI determined by either SCr level (0.04 [CI, −0.30 to 0.38] mL/min/1.73 m2 per year) or cystatin C level (−0.56 [CI, −1.28 to 0.17] mL/min/1.73 m2 per year) also had CI bounds that included the possibility of no effect. Limitations: Few cases of severe AKI, no adjudication of AKI cause, and lack of information about nephrotoxic exposures after hospital discharge. Conclusion: After pre-AKI eGFR, proteinuria, and other covariables were accounted for, the association between mild to moderate AKI and worsening subsequent kidney function in patients with CKD was small. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.